Hospices seek regulatory change to expand in-patient care

Martin B. Cassidy, Staff Writer

Published 12:40 pm, Sunday, April 17, 2011

STAMFORD -- At the Richard L. Rosenthal Hospice on Shelburne Road, terminally ill patients have their own rooms providing a more home-like environment to allow relatives and friends to visit them 24 hours a day during the final days of their lives, said Janice Casey, a consultant who works with the facility on patient care.

Off the lobby is a great room with sofas and other furniture, book-lined shelves, a keyboard with sheet music, and a small kitchen to warm up food, providing a comfortable area for patients to socialize with visitors, Casey said.

"It's meant to be a more comfortable and peaceful environment than a more sterile environment you would find in a hospital," Casey said.

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Since opening the 12-bed facility in June 2000, more than a thousand area residents too ill to receive hospice care in their homes have been admitted to the facility to receive round-the-clock nursing services and pain medication, while family members are offered spiritual and bereavement counseling and other services to help them cope with the impending loss of a loved one, Casey said.

Visiting Nurse & Hospice Care of Southwestern Connecticut, the owner and operator of the Rosenthal hospice and more than two dozen other providers of home and hospital hospice care in the state are pushing for approval of a draft set of revisions to state health regulations to help make opening licensed hospice facilities like the Rosenthal easier.

"The major goal for all of us should be to provide the best end-of-life care possible," said Casey, who worked as a nurse for Visiting Nurse & Hospice Care of Southwestern Connecticut for 21 years. "It's about the patients and their families and helping them through the process."

Currently, the Rosenthal residence is one of only three stand-alone hospice residences in the state, along with the 52-bed Branford facility and a 12-bed wing at Middlesex Hospital in Middletown.

Two years ago, the Visiting Nurse & Hospice Care agency obtained a license as a skilled nursing facility, allowing them to accept patients with more serious conditions, after years of trying to gain recognition as a hospice from the state, Casey said.

Like other hospice agencies, the current regulations have prevented hospice providers from being licensed to receive Medicare reimbursement for providing in-patient hospice care, and in the case of the Rosenthal, imposed additional staffing costs to meet the requirements of being licensed as a nursing home.

Dr. Joseph Andrews, medical director for Connecticut Hospice of Branford, said the more extensive standards for licensing in-patient hospices are appropriate, arguing the proposed change will result in hospice facilities with a lower standard of care, which will cause additional suffering for patients.

The new licensing regulations for hospice facilities would maintain a requirement to have a licensed physician as medical director, though change a requirement maintained by the Branford hospice to have a five physician medical team on staff.

Also eliminated would be a requirement to maintain an in-house pharmacy, and maintain a ratio of at least one registered nurse on duty per six patients in an in-patient hospice facility, according to the plan.

"If other hospices are to be developed they should really be held to the standard we've pioneered," Andrews said. "What I fear is unstaffed hospices with personnel on call and not in the building and you end up with people in emergency rooms because of poor care."

Andrews said he is especially concerned by the idea of in-patient hospices without a pharmacist on hand 24/7 to mix drugs when patients are in pain.

"When someone is reaching the end, what do we do with their OxyContin when they lose the power to swallow?" Andrews said. "You have to mix it into injectable form, and it has to be done quickly."

Casey and other administrators backing the changes said the Connecticut Hospice's concerns about the quality of care are unfounded, and that the regulations tailored by the Branford hospice in 1977 go far beyond what is needed to maintain a high standard of care for terminally ill patients.

Both home-care and in-patient facilities maintain pharmacy contracts to provide 24/7 service to provide pain medication and other palliative services to dying patients, Casey said.

"We're trying to run a hospice not a hospital," Casey said. "The Medicare regulations for hospice in-patient and home care also require you have ready access to medications."

Debra Healey, executive director of homecare for Middlesex Hospital, who oversees the hospice unit there, said while most hospice providers also provide some care in hospitals and nursing homes, the establishment of permanent hospices, with a more homelike environment, is better for the patient and their families.

"I feel that this is all about improving access and quality for the residents of Connecticut so they can go to facilities closer to their homes and loved ones," Healey said. "We can take care of patients in a nursing home but it is a different experience."

William Gerrish, a spokesman for the Connecticut Department of Health, said that the draft regulations bring the state's licensing requirements in line with Medicare's required standards for hospice care.

"We believe that the proposed revisions reflect high standards of quality and patient-centered care, including those for staffing and physical environment," Gerrish said. "Our goal is that these revisions will improve access to quality hospice care."